An essay on the treatment and cure of pulmonary consumption: On Principles Natural, Rational ...

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^M PULMONARY CONSUMrTION *"

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ON THE TREATMENT AND CURE

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PULMONARY CONSUMPTION.

BIRHINOHAM:
PRINTKU BY JAMBS DRAKB, 5!s>, XEW STBSKT.

AN

ESSAY

ON THE

TREATMENT AND CURE

OF

PULMONARY CONSUMPTION,

ON PRINCIPLES NATURAL, RATIONAL, AND SUCCESSFUL

WITH SUOGESTIONg FOB. AN IMPROVED PLAN OF TREATMENT OF THE

DISEASE AHOKOST THE LOWER CLASSES OF SOCIETT ; AND A

RELATION OF SEVERAL SUCCESSIYE CASES RESTORED

FROM THE LAST STAGE OF CONSUMPTION TO A

OOOD STATE OF HEALTH.

BY GEORGE BODINGTON,

SURGEON.

LONDON :

LONGMAN, ORME, BROWN, GREEN, & LONGMANS,

FATERNOSTER ROW.
MDCrCXL.

Mk 3.

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INTRODUCTION.

In venturing to put forth an Essay on the almost

hopeless suhject of the treatment and cure of Pul-

# monary Consumption, which has been so often written

ERRATUM.
Page 14, five lines from the bottom, for " affected," read ^ected,

increase, and the character and power of the medical
art, as a curative and remedial nieans, continues ob-
scured under a dark and cheerless cloud ; for these
reasons the Author trusts to obtain that forbearance
and indulgence from his medical brethren, of which he
is conscious he so much stands in need of; and that
they will deem every effort attended with any suc-
cess, in this important branch of medicine, of sufficient
value to warrant publication, even if the only effect

a2

ON THE TREATMENT AND CURE

ov

PULMONARY C ONSUMPTION.

VI INTRODUCTION.

one thus consuming awaj, under the influence of this
wasting disease^ a nutritious diet of mild, fresh
animal, and farinaceous food, aided hy the stimulus
of a proper quantity of wine, having regard to the
general state and condition of the patient. If this is
to he called the beef steak and porter system, then I
am guilty of patronizing it ; but, to my mind, it rather
has the character of a preservative system — whilst the
wasting plan is as much entitled to be called the
destructive one. Be that as it may, not having the
fear of "phlogiston" before my eyes — ^that "raw
head and bloody bones" of medical science — ^I have,
as will be found by a perusal of the following pages,
employed a nutritious and moderately stimulating
diet with much success ; and, without that, I do not
think the other means could have been so effectual,
or the treatment complete.

I have been brief and concise in drawing up this
small volume, preferring rather to form a strong out-
line than to enter into tedious detail ; besides that,
the filling up, in the treatment of individual cases,
must always be left to the judgment of the medical
attendant, who alone can direct the varieties of

INTHODUCTION. Vll

practice called for by peculiarities arising from con-
stitutional or other causes.

It will be observed, that the main ground of the
treatment has been to preserve or restore to a normal
condition, the functions of the nervous filaments,
interwoven with the substance of the lungs, and
exercising influence over the capillary system and
other parts of the organization : it has been assumed
that the first link in the chain of morbid actions
arises there, as they first feel the irritation from
the presence of the morbid matter deposited as a
foreign body, and that all the other changes are
consecutive to this wasting or destruction of the
fteryous energy of the filaments with which th«
tuberculous matter comes in contact. Upon
this view the treatment of ptOmonary consump-
tion, in the way herein recommended, has been
founded.

With the intention of further extending this mode
of practice, and of reducing it to a system of regularity
and order, as well as to be ready to meet the wishes
and hopes of some who may read these few pages, and
who might anxiously desire to reap the advantage

Vlll INTRODUCTION*

which this plan promises them, and wfiich some
have already obtained, to an extent beyond their
own, or the expectation of their friends, I have
taken for the purpose a house in every respect
adapted, and near to my own residence, for the
reception of patients of this class, who may be desir-^
ous, or who are recommended to remove from their
homes for the benefit of change of air, etc. It is pre-
sumed that, as the situation is very superior in point
of dryness, mildness, and purity of air, the advantages
to be derived from systematic arrangements with
regard to exercise, diet, and general treatment, with
the watchfulness daily, nay, almost hourly, over the
patient of a medical superintendent, great advantages
may be obtained by the consumptive patient treated
in this way, in comparison with those to be obtained
by the removal of such an one to a boarding
house or hotel merely for change of scene ; and
it is hoped that this plan may meet the appro-
bation of the medical profession, and prove be-
neficial to many aflElicted or threatened with the first
symptoms of this direful disease in this neighbour-
hood or elsewhere.

INTRODUCTION. IX

This fissaj has no pretension to a complete or
perfect work on the subject of which it is com-
posed ; much of it is the substance of reminiscences
of occurrences which took place several years since ;
but it has this to be said in its favour with regard
to the cases related, that the individuals who were
the subjects of them are alive and in good health at
the present day ; thus showing that the disease will
admit not only of palliation, but of cure. Some
of those individuals were despaired of by profes-
sional men of eminence, who were acquainted with
the state of their health previous to their undergoing
the treatment under which they recovered; and I
know, and their friends know, that opinions adverse
to any hope of their recovery were expressed. A
larger and more perfect work on the subject may
become necessary, as the result of more experience
and the collection of more facts may happen to be
made. The present Essdy has been written in a
somewhat hurried manner, when short intervals of
time could be snatched from occupations varied and
almost incessant. Hence, as a literary composition,
its imperfections are very great ; but as the aim has

X INTRODUCTION.

been to give the pith and substance of the matter
treated on, it is hoped this fault may be passed
over.

StTTON COLDFIELD, WARWICKSHIRE,

January i 1840,

ON THB

TREATMENT AND CURE OF PULMONARY

CONSUMPTION.

An uniform and complete success having resulted
in the treatment of several cases of tuberculous
consumption, upon the principles and plan ex-
plained in the following pages, the author deems
it his duty to publish them, with his opinions
and principles of treatment. It would not accord
M'ith the brevity and conciseness of the plan of
this treatise, to enter at length into the nature
and causes of consumption, the diagnostic symp-
toms, physical signs, morbid anatomy, etc. ; these
are subjects which have been elaborately handled
by several eminent authors, whilst little has yet
been done, by way of improvement, in the treat-

B

2 ON THE TREATMENT AND CURE

ment of the disease; Consumptive patients are
still lost as heretofore ; they are considered hopci-
less and desperate cases by most practitioners,
and the treatment commonly is conducted upon
such an inefficient plan as scarcely to retard the
fatal catastrophe. One mode of treatment prcr
vailing, consists in shutting the patients up in
a close room, to exclude as far as possible
the access of the atmospheric air; and thus
forcing them to breathe over and OTcr again
the same foul air contaminated with the diseased
effluvia of their own persons. But what could
rationally be expected to be the result from such
practice, than that of the conversion of a slow or
moderate consumption, into an intense or gallop-
ing one ? This is, indeed, a treatment founded
on the most erroneous principles, and is much
more deserving of reprobation than is even the
apathetic indifference and desperate hopelessness
generally entertained with regard to this disease.
To aid the powers of the close room system,
tartarized antimony is often given in excessive

OF PULMONARY CONSUMPTION. 3

doseis, and generally with the effect of nearly
destroying the patient : It materially assists the
disease in destroying the powers of nutrition,
the muscular power, and the functions of the
skin, at the same time increasing the nervous
excitement Patients seldom surviye long the
use of this medicine, when administered freely,
if the disease is much advanced, unless an anti-
dote to the poison be timely given. I have
never seen anything but mischief arise from the
use of it; it is entirely inconsistent with the
method and the principles upon which I have
successfully treated the disease. It is, however,
at the present time, a fashionable medicine, and
I may add a most destructive one. I am quite
sure that the employment of this (remedy?)
hastens the fatal event.

Digitalis is another drug that has been vaunted
as a remedy for consumption : It has the power
of controlling the action of the heart, and dimi-
nishing the number of its beats ; therefore, it has
been argued, it must or ought to be serviceable

B 2

4 ON THE TREATMENT AND CURB

in this disease. It is perfectly well known, that it
entirely fails even in retarding the progress of con-
sumption ; it has no power to cure that disease ^
and I shall be able to show clearly, that the
diminution and regularity of action in the heart
and arteries is to be attained by far different
means than by the use of digitalis.

I believe, having mentioned the shutting up
plan in close rooms, the use of antimony and
digitalis, if I add the use of demulcents, of
blisters, leeches, plasters, etc., I shall have de»
scribed the helpless and meagre system of
medical treatment of consumption in general use
at the present day, the utter uselessness of which
is so well known and so obvious, that the mem-
bers of the medical profession in the towns, are
in the habit of dismissing their patients to some
distant sea-port or watering-place, where, falling
under precisely the same mode of treatment,
they there commonly die. The gravestones
in the churchyards of many of these places of
resort of the consumptive patients, bear testi-

OF PULMONAEY CONSUMPTION. 6

mony to the truth of this remark. There is
nothiDg gained by resorting to the coast; in
truth, the interior of the island is the best ; the
air is just as pure and much milder, and more
suitable for the lungs of consumptive people, if
they will but breathe it. There is but one other
proposition in the way of treatment to which I
hare to allude, I mean to the inhalation of
gases of various kinds, by which means it is
proposed to convert the cough of consumption
into a catarrhal cough, which catarrh is to con-
tinue so long as the patient lives, or, discon-
tinuing, the consumption would supervene. We
have not heard what success has attended this
method of treatment, but it may be fairly inferred
that such an artificial mode of proceeding, so
contrary to the dictates of common sense and
sound principles, could not sustain itself for long,
and must have perished nearly at its birth. The
only gas fit for the lungs is the pure atmosphere
freely administered, without fear; its privation
is the most constant and frequent cause of the

B 3

6 ON THE TREATMENT AND CURB

progress of the disease. To live in and breathe
freely the open air, without being deterred by the
wind or weather, is one important and essential
remedy in arresting its progress; — one about
which there appears to have generally prevailed,
a groundless alarm lest the consumptive patient
should take cold : Thus one of the essential
measures necessary for the cure of this fatal
disease is neglected, from the fear of suffering
or incurring another disease of triping import.
No two diseases can be more distinct from each
other than consumption and catarrh; it is the
latter only which might be caught by exposure
to atmospheric causes; with the former they
have nothing to do. Farmers, shepherds, plough-
men, etc*, are rarely liable to consumption, living
constantly in the open air ; whilst the inhabitants
of the towns, and persons living much in close
rooms, or whose occupations confine them many
hours within doors, are its victims: The habits
of these latter ought, in the treatment of the
disease, to be made to resemble as much as

OF PULMONARY CONSUMPTION. 7

possible those of the former class, as respects
air and exercise, in order to effect a cure- How
little does the plan of shutting up the patients
in close rooms accord with this simple and
obvious principle. As to the result of such
a practice, it is known to all, one-fifth of
the deaths annually in England are from con^
sumption, whilst cures are scarcely ever heard
of, and never expected : Despair seems to
have taken full possession of the medical
profession as regards this destructive disease,
and none but the feeblest efforts are exerted to
oppose its progress. The successful treatment
of several cases successively, of severe, decided,
and genuine, tubercular consumption, on prin-
cipleS) I believe, differing from the usual routine
of practice, and from the doctrines and theories
of the present day, which form the basis of
medical practice, induces me to lay those cases
before the public, and to explain my views and
principles of treatment on which that success
was founded.

8 ON THE TREATMENT AND CURE

When I began to practice medicine as an axt,
after having imbibed the theories of the schools,
I very soon found the necessity of laying them
aside as a guide, having discovered, as I believed,
that the practice founded thereon was useful to a
certain extent only, and as far as that went, fit to
be employed ; but that it was worse than useless
when employed like a talismanic wand, to unlock
and overcome every difficulty that might present
itself. Thus I found that it was for the most
part useful to preserve as much as possible, in
very many diseases, the muscular power, con-
tractility; but that antiphlogistic treatment, as
it is called, had a direct tendency to destroy it.
Again: To preserve the powers of nutrition I
have found needful and beneficial always when
they can be maintained; for disease makes a
slower progress when opposed by a firm mus-
cular tone and good nutritive powers. Anti-
phlogistic treatment directly impairs and destroys
the powers of nutrition. Again : In order to
oppose the progress of disease I have found it

OF PULMONARY CONSUMPTION. 9

of paramount importance to allay nervous excite*
ment locally and generally ; that is, to endeavour
to bring to a healthy action the nervous influ-^
ence from that morbid, irregular, or inefficient
action which it exerts under the influence of
disease. If the nervous system can be preserved
entire, disease will be overcome, and healthy
actions be maintained. If disordered nervous
actions are restored to a healthy state, the
functions of all the lower tissues dependent
upon them will resume a healthy condition ; for
this purpose Nature has provided man with a
bountiful supply of remedies, in the whole class
of sedative and anodyne plants. In the proper
use and application of these medicines, is to be
found the means of restoring disordered nervous
power to a healthy standard. I shall have to
show, by and by, their important use in the treat-
ment of consumption. Antiphlogistic treatment
carried out exclusively in the usual way, and
in accordance with the doctrines of the schools,
has a tendency to excite and irritate the nervous

10 ON THE TREATMENT AND CURE

system, and to weaken its powers over those
tissues which rank below it in the scale of
animal life ; consequently, it has a tendency to
destroy every natural bulwark to the progress of
morbid actions.

If consumption is considered in this light, we
shall find the first step of its progress consists in
nervous irritation, or altered action, or weakened
power, in the substance of the lungs, from the
presence of tuberculous matter deposited there as
a foreign body. In consequence of this condi-
tion of the nervous power, the contractility of
the lungs becomes impaired in its membranes,
ceUular substance, and blood vessels. So soon
as the nervous power is entirely destroyed in
those portions of the lungs where the tuberculous
deposits exist, then the destruction of the re-
maining tissues follows immediately; they die,
dissolve down into a half fluid half putrid condi-
tion, and are expectorated through the bronchial
tubes, leaving cavities in the substance of the
lungs which can be never healed but under the

OF PULMONARY CONSUMPTION. 11

most favourable combination of circumstances.
Here is then, first, nervous power altered, weak-
ened, or exhausted ; then the destruction of the
remaining tissues, constituting the main substance
of the organ. To preserve the latter, the integrity
and strength of the former must be maintained ;
and upon the means necessary for that purpose
the whole question turns. I shall endeavour \o
explain those I have employed successfully in a
plain, distinct, and intelligible way, to all classes
of readers ; for not only the medical profession,
but every family is interested, and ought to be
made acquainted with the means of guarding off
this fearful ^malady, and of rescuing its victims,
wherever it makes an attack.

Those persons who are for the most part the
freest from the attacks of consumption, such as
agricultural labourers, are commonly but little
troubled with nervous disorder ; they are rather
remarkable for an apparent obtuseness of nervous
susceptibility, and this is in strict keeping with
fully developed muscular, nutrient, and san-

12 ON THE TREATMENT AND CURE

guiferous powers. This nerrous quietude har-
Tnonises exactly with this condition of the latter
powers; it is a plain inference that, to guard
against the attacks of consumption, the condition
of the patients should be assimilated as much as
possible to that of the above-named class of
individuals. The nutrient, muscular, and san-
guiferous systems must be maintained in the
highest perfection that is possible; the nervous
system quieted, subdued, and rendered obtuse.
The relation of the cases I have treated success-
fully will best show the means of effecting these
objects. By a subdued and healthy condition of
nervous power, and by a full and complete conr
dition of health as regards the nutrient system,
etc., the nervous system of the substance of the
lungs, those nervous fibres immediately acted
upon by the tuberculous deposits, will not yield
to their influence. Tuberculous matter is often
found deposited upon sound lungs, where it has
been rendered harmless, by a vigorous state of
nutrition, and the sanguiferous system; but let

OF PULMONARY CONSUMPTION. 13

individuals thus affected be exposed to the
causes of iuDutrition, and there are but too
many, by which the muscular and sanguiferous
systems lose their tone and become weakened,
and you have removed the barriers to the pro-
gress of consumption ; the nerves of the lungs
are no longer able to resist the morbid impres-
sion from the presence of the tuberculous matter,
their energy becomes exhausted, ulcerations and
excavation of the substance of the lungs follow,
constituting consumption.

In order then to restore a consumptive patient,
it will be necessary especially to attend to the
following matters. We shall find first of all
a rapid and weak pulse, ranging from 120 to
140 beats in a minute, clearly indicating a
deficient supply of blood, and the heart and
arteries irritable in proportion to this defi-
ciency. This condition must be met at once,
not by the means termed ^^antiphlogistic," but
with frequent supplies, in moderate quantities, of
nourishing diet and wine; a glass of good

c

14 ON THE TREATMENT AND CURE

Sherry or Madeira in the forenoon, with an
egg, another glass of wine after dinner, fresh
meat for dinner, some nourishing food for supper,
such as sago, or boiled milk, according to the
taste and digestive powers of the patient. This
will be supplying means to rectify the mor-
bid condition of the nutritive functions, and to
allay the irritability of the heart and arteries.
I have generally succeeded in the course of a
few days, or perhaps a week, in reducing the
pulse from 130 or 140 down to 90, by means
of this diet, and by a systematic use of seda-
tive medicines, and other means. The whole
nervous system is unduly excited, or affected in
some way we know not how to express or under-
stand, from our limited knowledge of it, when
under the influence of this disease, and neither
can nutrition be affected, or the muscular system
recover strength, or the vessels be filled with a
due supply of the vital fluid, unless that nervous
disorder be allayed and soothed, or rendered
more in accordance with a healthy condition.

OF PULMONARY CONSUMPTION. 15

The plan to obtain this. object is^ to give
alterative doses of sedatives, and also direct or
full ones. The former consist of moderate doses
given at intervals throughout the day, with the
view of allaying the general nervous excitement.
The direct or full dose is given at bed-time, to
allay coughing and procure sleep. Aconite,
henbane, or the salts of morphia may be used.
I have preferred generally the hydrochlorate.
of morphine : A sufficient dose to procure a
whole night's repose should be given every
night, in addition to the alterative doses above
mentioned; the latter may be administered,
in an almond emulsion, in doses repeated
three or four times a day. Should the medi-
cine produce constitutional effects, paleness,
faintness, sickness, giddiness, it must be laid
aside for a period, and an antidote will be found
in small quantities of weak brandy and water, or
wine and water. The sedative medicines should
be resumed so soon as these effects are removed.
I come now to the most important remedial

c 2

16 ON THE TREATMENT AND CURE

agent in the cure of consumption, that of the
free use of a pure atmosphere ; not the impure
air of a close room, or even that of the house
generally, but the air out of doors, early in the
morning, either by riding or walking ; the latter
when the patients are able, but generally they
are unable to continue sufficiently long in the
open air on foot, therefore riding or carriage
exercise should be employed for several hours
daily, with intervals of walking as much as the
strength will allow of, gradually increasing the
length of the walk utitil it can be maintained
easily several hours every day. The abode
of the patient should be in an airy house in the
country ; if on an eminence the better : The
neighbourhood chosen should be dry and high ;
the soil, generally of a light loam, a sandy or
gravelly bottom ; the atmosphere is in such
situations comparatively free from fogs and
dampness. The patient ought never to be
deterred by the state of the weather from exer-
cise in the open air; if wet and rainy, a covered

OF PULMONARY CONSUMPTION. 17

vehicle should be employed, with open windows.
The cold is never too severe for the consumptive
patient in this climate ; the cooler the air which
passes into the lungs, the greater will be the
benefit the patient will derive. Sharp frosty
days in the winter season are most favourable.
The application of cold pure air to the interior
surface of the lungs is the most powerful sedative
that can be applied, and does more to promote
the healing and closing of cavities and ulcers
of the lungs than any other means that can be
employed; for it is by the use of the means
which have the power of restoring to a healthy
condition the nervous system, interwoven with
and forming a portion of the substance of the
lungs, that healthy actions can be induced in
the remaining tissues. This, then, is to be
aimed at, — a healthy nervous system, which
will embrace in its consequences, due sensibility,
motive power, nutritive and reparative power, —
conditions necessary to resist and overcome the
morbid influence arising from the presence of

c 3

18 ON THE TREATMENT AND CURE

tuberculous matter. Many persons are alarmed
and deterred from taking much exercise in the
open air^ from the circumstance of their coughing
much on their first emerging from the warm
room of a house; but this shows that the air
of the room was too warm, not that the common
atmosphere was too cold. To live in a tem-
perature nearly equal to the latter at all times
should be the aim of the ps^tient, who should
avoid warm close rooms as much as possible,
and always keep away from the fire, taking care
to keep the surface of the body warm by suffi-
cient clothing. Thus the equal temperature so
much considered, and said to be necessary,
should be that of the external air, instead of
that so commonly employed, the warmth of a
close room.

In order eff'ectually to overcome consumptive
disease, all these several circumstances will be
required to be adopted and followed up with
the greatest attention, regularity, assiduity, and
patience. Of those cases which I have treated

OF PULMONARY CONSUMPTION. 19

upon these principles^ having had some of the
patients under my own roof, by which I secured
all the advantages of situation, etc., before
spoken of, and some in my immediate neigh-
bourhood, so that I could closely watch them,
I have met with signal success, and scarcely an
instance in which this mode of treatment has
been fully carried out in all its particulars
wherein the consumptive symptoms have not
gradually yielded, and the patients restored to
complete health. I shall now proceed to give
an outline of the history of the treatment of
several cases.

One occurred in the person of an awl
blade grinder, living in the country, in the
year 1833. He was of a consumptive family,
a sister of his had died at about the age of
twenty years, and others of his nearest rela-
tives had died from the same disease. There
could be no stronger exciting cause for the
development of the disease than that which
arose from his daily occupation; he was about

20 ON THE TREATMENT AND CURE

thirty years of age^ of fair complexion, florid,
shoulders high, chest narrow, and his general
figure rather spare and slender. His fin-
ger nails were incurvated; he was troubled
with a pain in his side; and a cough more
or less without intermission. It was upon the
accession of a sudden attack of consumption
that I was called in to attend. A feel-
ing of suffocation affected him, which was
distressing, arising from the pressure of an
abscess in the bronchial passages, attended with
irritative fever; the breathing was relieved by
the bursting of the abscess, and the free ex-
pectoration of pus and mucous. A cavity was
formed in the upper portion of the substance of
the lungs; the pulse beat 140 in a minute; he
had profuse night perspirations ; and his respira-
tion was exceedingly quickened. He was much
exhausted, and fully impressed with a belief
that his life was about to terminate. He had
no inclination for food of any kind; his muscles
were relaxed and powerless, and his whole

OF PULMONARY CONSUMPTION. 21

frame collapsed. Under these circumstances,
had the antiphlogistic treatment, or even any
part of it, been adopted, I believe he would
have sunk past recovery; and yet would not
this be called acute inflammation of the sub-
stance of the lungs ? and are not the remedies
for this said to be, bleeding, blisters, calomel,
antimony, digitalis, purgatives, etc.? But any
of these, I firmly believe, would have hazard-
ed his existence; the application of the anti-
phlogistic routine would have destroyed him.
The treatment adopted was this: Seeing that
nutrition was at a stand still, that the muscular
power was collapsed, and the sanguiferous sys-
tem running away, at the rate of 140 beats per
minute; to counteract these dangerous symp-
toms, he took, first, a wine glass of port wine,
and repeated it in a few hours; at bed time
he took a sedative draught, and slept well;
he continued to cough, and expectorated freely
pus and mucous ; he took at intervals small doses
of hydrochlor. morph., about a tenth of a grain;

22 ON THE TJEtEATMENt AND CtRE

thiS; and the full dose he had taken on the
previous night, allayed, in a great degree, the
nervous excitement in the lungs, and the irri-
tative fever subsided; but the cough, debility,
and expectoration continued ; there was a cavity
of the lungs to-be . healed. I told him
that could not be done without a strenuous
effort on his part; and explained to him my
views as to the beneficial effects to be obtained
by early rising, and remaining out of doors a
considerable time in the open air; that this
would soothe, expand, and invigorate the
lungs, so that the sores would soon heal, and
that by no other means could he be cured;
that if he remained within dbors, shut up in
the house, more abscesses would be likely to
form, and the irritative fever again attack
him. He saw the force of this advice, and
determined to follow it, being a man of much
firmness of character. All this occurred on the
second day after the acute attack. On the
next day following he related to me, nearly in

OF PULMONARY CONSUMPTION. 23

these words, the particulars of his morning
walk: "I got up about four o'clock, and crawled
out of the house as well as I could, and felt,
and, I believe, looked, the most miserable, weak,
and pitiable wretch in the world. I crept
along, panting for breath, towards the common ;
I thought I must have died on the road; at
last I reached Welchman's Hill, and when I
began to walk round it, I felt my lungs open,
my breathing free, and my strength increase
fast. I was now sure it was doing me good;
I went quite round the hill, and then home, and
was so hungry that I ordered a beefsteak for
breakfast, and ate heartily of it." The distance
he walked would be about three miles. . The spot
called Welchman's Hill, is said to be equal in
elevation to any table land in the island. The
soil lying on a sandy or gravelly bottom, the
air is very pure and mild. He continued for
some time daily to pursue the same course, and
became convalescent in a week, losing his cough
entirely. I wished him to change his employ-

24 ON THE TREATMENT AND CURE

mcnt, but his circumstances forbade that. He
resumed, after a short interval of rest, his trade
of an awl blade grinder, and continues it to
this time. He has had symptoms of a return
of his disorder on several occasions since, and
informs me that when that is the case, he
betakes himself early in the morning to the
common, and that always prevents any se-
rious attack. The cure in this case was
obtained by means applied to stimulate and
invigorate the nutritive, sanguiferous, and mus-
cular powers; wine and such nourishing diet
as the stomach could bear, and by means
applied to soothe and allay nervous excitement,
locally and generally; first, by a full dose at
night of the pauriate of morphine, followed by
small alterative doses given every five or six
hours ; secondly, by the application of the early
morning air to the internal surface of the lungs,
continued for several hours, accompanied with
muscular exertion. The change in the character
of the expectorated matter is very striking:

OF PULMONARY CONSUMPTION. 25

As so(ni as the full clTects of the morning air
are experienced, it becomes light, white, more
transparent, and devoid of puriform matter; it
has more of the nature of mucous, and is no
longer heavy, yellow, and solid. So powerfully
does this remedy affect the lungs as a sedative,
allaying and subduing nervous disturbance, at
the same time inducing a vigorous tone of the
digestive apparatus, and of Uie nutrient functions
generally, that it will, if boldly and thoroughly
applied, directly and entirely change the cha-
racter of the cough, and completely remove the
wasting irritative fever.

The next opportunity I had of witnessing the
advantages of the mode of treatment described,
occurred in the case of a young lady, about
sixteen years of age, whose parents, brothers,
and sisters, were all at this time healthy ge-
nerally; consumption was not known in the
family previous to her case, but at the present
time her brother suffers from the disease. For
several years she had suffered occasionally from

26 ON THE TREATMENT AND CURE

pain in the side, cough, and debility. In 1835
she retui*ned home from a boarding school,
where she had been placed under medical treat-
ment for these complaints; she was still ill,
and her friends thought it advisable she should
go to the sea coast. She went near to Liverpool ;
the sea air had a bad effect, the pain and cough
increased, she was placed under medical care,
and went through a long course of treatment.
She continued to get worse in every respect, and
her friends saw the necessity of her removal
home ; and she came to her native air in War-
wickshire in October, 1836, after an absence of
several months. Her friends were impressed with
a notion that the iodine which she had been
taking, if persevered with, would be ultimately
successful. This very interesting patient came
under my care. Her parents, relatives, and nu-
merous friends, were watching her with the
deepest solicitude; for she was, by all who
knew her, most highly and justly esteemed. I
found it necessary, at least for a short time, to

OF PULMONARY CONSUMPTION. 27

«

acquiesce in the treatment by iodine, although
there was but little hope of any advantage
from it. * I met several medical men in consuK
tation, and a treatment was pursued in the usual
manner ; the patient being confined to her room,
and consumption gradually wearing her away.
I had explained my views to her friends respect-
ing air and exercise out of doors, but could
not succeed in gaining their consent to the
plan. The two months of November and De-
cember were thus lost to the patient, or rather,

during that period every symptom of the disease

«
had become aggravated ; she was now extremely

emaciated, suffered from profuse night perspira-
tion, violent cough, and difficulty of breathing,
the expectoration was abundant, consisting of
mucous, mixed with opaque solid portions fre-
quently tinged with blood, most of which
sank in water, some floated. There was a
dull sound on percussion of the upper portion
of the lungs, mucous rattle, with a gurgling
noise, and a hoarseness, and weakness of voice ;

D 2

28 OF THE TREATMENT AND CURE

»

the physical signs, in combination with the gene*
ral symptoms, were clearly indicative of the ex-
istence of cavities in the upper portion of the
lungs. In the month of January, 1836, the case
was left entirely to my management^ and having
urged my views strongly to her friends, I gained
their consent to their being adopted. A donkey
was procured, on which the patient began to
take exercise out of doors, notwithstanding the
inclemency of the season, in the depth of winter.
The first trial was unpromising; the cough
appearing to be much increased in coming into
the open air from the warm bed room. This
arose from the undue closeness and heat of the
bed room, and not the external air. There
cannot be a more fatal error than that which
arises from the supposition of there being some-
thing deleterious in the external atmosphere,
because persons cough when first brought into
it, out of unwholesome heated apartments : The
latter should be especially avoided, and the
apartments kept cool and airy, corresponding

OF PULMONARY CONSUMPTION. 20

in temperature nearly to tbe external atmo-
sphere, whilst the former should be courted and
indulged in to the utmost. The surface of the
body may and should always be kept warm by
sufficient clothing, the lungs cool by the con-
stant access of cold pure air to them; thus
undue heat is . driven from the interior to the
surface. In the present instance it w^as soon
found that by continuing a long time out of
doors the cough abated materially; every day
some improvement was observed to take place,
very gradual, but constant. A sedative draught
was gi^-^n every night, which, together with the
exercise of the day, procured sleep and warded
off the cough till morning. In the day time an
emulsion mixture was taken at intervals, and
very small doses of morphine, to subdue by
degrees the irritation arising from the presence
of tubercles in the lungs. The diet was nourish-
ing, consisting of boiled egg, fresh meat, milk
and bread, and two glasses of Sherry in water

daily. This treatment was continued
D 3

30 ON THE TREATMENT AND CURE

very strictly through the winter and spring
months of the year 1836; by June the patient
had entirely lost her cough, with all the other
symptoms of the disease, regained her health
and strength, and passed through the succeeding
winter in veiy good health, accustoming herself
to go out of doors, walking or riding almost
daily. At this time, July 1839, she is in perfect
health.

Nov. 14, 1836. A young lady about twenty-
three years of age, residing at Birmingham, of
a consumptive family : Two sisters and a brother
died of the disease. She had been suffering
several months from cough, pain in the side,
emaciation, difficulty of breathing, and a pulse
140 ; she had all the usual sjrmptoms of consump-
tion in its last stage : In this condition she was
placed under my roof, for the purpose of under-
going a treatment similar to that last detailed.
As her brother had so recently died, and other
members of her family, and her symptoms in all
respects resembled theirs, her fate was thought

OP PULMONARY CONSUMPTION. 81

inevitable by ber friends; she was therefore
brought to me as a forlorn hope. She came on
the 14th of November. On the 15th she was
called up at eigtit o'clock, a.m.9 after a bad
night of incessant coughing. After breakfasting
with what appetite she had, she got into an
open phaeton, and was driven four miles. She
coughed at first, but in ten minutes it ceased;
she alighted at a house and went into a warm
sitting-room, where the cough returned imme-
diately; after a short stay she returned home,
and on the road the cough nearly ceased to
trouble her. She took a little wine and water
at eleven, a.m., and at two, p.m., dined on fresh
mutton. In the afternoon, lode out on the don-
key some time ; retired to bed at eight o'clock,
taking an anodyne draught of morphine. She
slept well, and on the 16th rose at half^past
seven. After breakfast she rode out on a
donkey and walked alternately till one o'clock.
After dinner, drove out in the phaeton four miles
and back. Coughed rathev more this afternoon ;,

82 ON THE TREATMENT AND CURE

pulse, 120; appetite moderate; an anodyne
draught at bed time.

nth, — Cough continues; the strength im-
proves ; out of doors morning and afternoon,
riding and walking; anodyne draught at bed
time.

25th. — Has been gradually improving since
the 17th; has been out of doors every day,
sometimes walking, at others riding in the
phaeton; sleeps well, the cough being trouble-
some only at rising in the morning ; coughs
but little when exercising out of doors; takes
an almond mixture . in the day time, anodj'ne
draught eveiy night.

29/A. — The weather very stormy, the rain
falling in toirents;' notwithstanding which, at
intervals when the rain ceased, the patient
walked in the garden, morning and afternoon.
Had a severe coughing fit last night; has
scarcely coughed at all to-day. Eats moderately
of plain animal and farinaceous food ; drinks a
small glass of Sherry wine in water daily after

OV PULMONARY CONSUMPTION. SS

dinner; the anodyne draught at bed time, and
almond emulsion occasionally. Her health alto^
gether is greatly improved.

Dec. 24. — The same treatment continued
steadily up to this day, when she was con-
sidered well, and went home to Birming-
ham. She had taken exercise out of doors
every day in some form or other; now her
appetite is very good ; breathing, free and easy ;,
pulse, strong, firm, and not too quick; sleeps
well, the cough seldom troubling her in the
night, and quite absent in the day time; she
is active ami strong, and regaining flesh fast;
eats ^fmdampm for breakfast and supper with
advantage, drinks Sherry and water after dinner..

She remained at home comparatively well until
she caught the influenza, which prevailed as
an epidemic in the months of January and
February, 1887. The disease ran through the
family, and none sufiered so severely as my
])atient. I had not the management of
her under this attack, until, whether from the

34 ON THE TREATMENT AND CURE

effects of the disease, or from- the active and
debilitating treatment employed, or both, she
lost all the advantage she had obtained when
under my care, the whole train of consumptive
symptoms returned with greater severity than
before. The debility was so great that she
could not support herself, and, after a con-
sultation with her mother, I arranged once
more to receive her under my roof. She was
conveyed in a car to my house, a few miles
from Birmingham. The same plan of treatment
was immediately followed which had before
proved so beneficial, and, in the space of three
weeks or a month, she again recovered, and,
with the occasional use of the anodyne draughts,
has remained tolerably well up to the present
period.

May 16, 1839. — S. R., a mamed man, about
thirty years of age, lives in service at —
L.'s, Esq., Handsworth, near Birmingham. A
few months since had an attack of haemoptysis ;
since then has been subject to cough ; the cough

OF PULMONARY CONSUMPTION. 35

is become permanent, incessant night and day ;
expectoration free ; breathing short, especially
on taking exercise ; sharp pains through
the chest, on the right side; great debility,
and wasting of the body ; excessive perspira-
tions in the night; pulse 120; the tongue
clean ; eyes have a glassy expression, pupils
dilated; complexion florid and fair; stature tall;
chest rather narrow. His father died at six
and twenty, of consuuiption. In addition to
these symptoms, percussion afforded a dull sound
on the upper part of the chest; auscultation
discovered mucous rhoncus, with gurgling, on
coughing. There was an excavation in the
upper portion of the right lung, accompanied
with all the usual symptoms.

TREATMENT.

The nervous excitement was combated by
daily small doses of mur. morphinae ; by the
frequent application of cool air to the surface
of the lungs, by walking or riding out, begin-

36 ON THE TREATMENT AND CURE

ning at five or six o^clock in the moroing*
The wasting, innatrition, and muscular debility,
and the accelerated pulse, clearly indicated
the necessity of two glasses of wine daily,
an egg at eleven o'clock p.m., fresh meat for
dinner, tea in the afternoon, and gruel for
supper. He took a dose of almond emulsion
three times a day; slept on a fiock bed;
and used tepid sponging with vinegar and
water every night, whilst he had profuse per-
spirations; bed clothes light

May 18/A. — Improved; cough diminished;
slept well last night; pulse 80, softer, fuller;
breathing more free ; stronger ; expression of
countenance much improved; rode on horse-
back six miles; continue treatment as
before.

^\st, — Rode on horseback; rose at half-
past five; walked out for an hour, to the farm
house near, drank a little new milk; improv-
ing; sleeps well; ieippetite better; pulse 80;
cough much diminished; breathing more fif^e;

OF PULMONARY CONSUMPTION. 37

no night perspirations ; omit the sponging ;
continue treatment as before.

24/A. — He walked this morning four miles;
pulse 86 ; cough nearly gone ; appetite good.

27th, — Continues improving.

30M. — Walked again four miles without feel-
ing fatigued ; sleeps well ; coughs at first rising
in the morning; after dischai*ging mucous,
remains free from the cough till the afternoon,
when he has another fit of it; strength in-
creasing daily.

June 1. — Is well, with the exception of a
slight cough, and expectoration of mucous, on
lising in the moruing; wishes to be allowed
to return to work, as a groom, gardener, etc.

8/A. — Walked four miles again feeling no
fatigue; coughs occasionally in the morning;
appetite good ; breathes \i'ith freedom.

Wth. — Has resumed his daily occupations;
his strength being restored, wine no longer
needful; appetite good; digestion easy; drinks
toast and water.

E

38 ON THE TREATMENT AND CURE

18///. — Called at the surgery; quite reco-
vered.

A young man about nineteen years of age, after

»

having ^ year before suffered from hasmoptysis
severely, and subsequently from slighter attacks
of that disease from time to time, became the
subject of a very severe hypocondriacal affec-
tion, which in the month of August, 1889, ter-
minated in the development of tubercular con-
sumption, characterised by frequent cough, and
expectoration of mucus and pus, or matter of
an ashy colour, sinking in water ; by nocturnal
profuse perspirations, shortness of breathing,
emaciation and great debility ; pulse ranging
from 130 to 150 beats in a minute ; respiratory
murmur, almost imperceptible ; percussion over
the clavicles gave a dull sound; internal reso-
nance of the voice and cough on the right side ;
the whole symptoms physical and natural clearlj'
demonstrating, the existence of ulceration and
excavation of a portion of the lungs, constituting
the last stage of consumption.

OF PULMONARY CONSUMPTION. 39

TREATMENT.

Aug, 6th, 1839. — Takes a glass of new milk
before breakfast; rises at six a.m., and walks
in the garden ; breakfast, tea and toast ; rides out
afterwards; lunch, milk and toast; dinner, fresh
meat and bread ; three glasses of Sherry wine
daily, at eleven a.m., at two p.m., and at seven
p.m. ; afternoon, exercise in the open air, riding
or walking ; retires to bed at eight ; takes an ano-
dyne draught of mur. morpliinse; pulse 130.

Sth. — Milk diet disagreeing with the sto-
mach, takes beef tea,' sago, fresh meat; Sherry
wine and water after dinner and in the evening ;
eight p.m. much relieved by the omission of
milk in the diet; pulse 120, fuller and softer;
cough, expectoration, and night prespirations
continue; repeat anodyne draught at bed time.

Sept, Srd, — Patient continues under treatment,
pursuing in all respects the plan daily as above,
namely, three or four glasses of wine daily, with
a good supply of fresh animal food, sedatives,
demulcents, early rising, and going daily out

E 2

40 ON THE TREATMENT AND CURE

of doors^ when the weather permits, and when
at home, sitting for the most part with the
window wide open, and without a fire, except
occasionally in the evening; under this treat-
ment the disease at present appears arrested in
its progress; there is improvement as regards
the cough, the quantity of expectoration, and
the night perspirations, but the pulse continues
to beat from 120 to 130 in a minute, and
when at all excited even 140. This is the most
difficult case I have hitherto encountered, and
the most doubtful, as to its favourable termina-
tion, arising from the complication of morbid
affections the patient has been the subject of,
namely, of haemoptysis, hypochondriasis, and a
few years since of a fistula in ano, some efiects
of which he still suffers from ; but I purpose
to publish, if I have opportunity, a faithful ac-
count of the result of this, and of every case of
this description which I may happen to have
the opportunity of treating, upon the principles
herein described, on a future occasion.

OF PULMONARY CONSUMPTION. 41

One case more which I shall describe from
reminiscence, having no notes of it, will show
the applicability of the treatment to acute con-
sumption. About two years ago, I was desired
to see Mrs. L., the wife of a tradesman, about
thirty years of age, tall in person, and of fair
an^ florid complexion. She was \jing in bed,
in extreme agony, from difficulty of breathing,
arising from an internal tumour which she de-
scribed she felt pressing upon the lower part of
the throat She was pale, and bathed in per-
spiration, large drops hanging about her fore-
head and face. The pulse was exceedingly
quick and small, and the breathing terribly
oppressed. Eight or ten leeches were quickly
applied to the lower part of the neck, just
above the sternum ; and shortly after their
application, her month became suddenly filled
with matter of a pamlent character, which
she ejected ; the breathing became free, congji
and expeetoratian remaining. She took a seda-
tire draught at night, and slept well. In the

42 OM THE TREATMENT AND CURft

moruing the cough relumed, and the expectora-
tion was great, consisting of mucus and pus
mingled. The irritative fever had greatly de-
clined. A large bronchial abcess had been the
cause of the symptoms, and its bursting afforded
the relief which the patient felt. The question
now was, as to the best means of healing the
cavity, and preventing the acute attack degene-
rating into chronic consumption. The means
employed were these : As she had been much
exhausted, she was directed now to take occa-
sionally a little wine and water, good beef tea,
sago, etc. ; sedatives were given her in small
doses, and a full dose at bed time. She was
advised immediately to quit the bed room, and
go into the open air as much as possible, that
she might obtain the benefit of the soothing and
sedative properties of cool air applied to the
inner surface of the lungs, being well clothed
and guarded from wet and damp. She strictly
followed this advice ; and in one week's
time, I met her riding several miles from home.

OF PULMONARY CONSCMPTIOX. 43

and beard her express very cheerfully, that
she considered herself quite well. Her gene-
ral appearance and expression was decidedly
of that character which is indicatire of a tuber-
culous habit; and the bronchial abscess was
probably the result of tuberculous deposit, and
the case altogether a specimen of the acute form
of consumption.

The method of treatment in the foregoing cases
is then, I think, entitled to be called natural and
rational ; that it is successful is obvious, each of
the indiTiduals thus treated, except the last but
one, sUn mider treatment, has remained since
their core in good and comfortable health, and
they hare obtained this adrantage, that they now
know ihemselre» so well the best means of cure,
and Ibey empiojr ihom mean* eflketnally to ward
off any ftieidi aHaefc. Sereral years hare elapsed
since Ihe r^itoralMMi to health of the two young
ladk«^ a»4 1h^ n^^ibm of them hare mice sof-
fered ^mim^y fom anj i^Mwe of the longs.
Tbey f9 m mmi^ m Hk^ cm into the open air.

44 ON THE TREATMENT AND CURE

walk much, live well, and avoid every source ^f
bodily debility as much as possible, especially
that which might arise from the imprudent use of
that kind of medical treatment which goes by the
term of "Antiphlogistic," well knowing that if
they should sink below a certain degree of
vigour and health from this cause, or any other,
consumption would immediately make inroads
upon their constitutions, and endanger their
existence.

The generality of the medical profession have
not the opportunity of thus treating their con-
sumptive patients; if they are to succeed,
they should have country houses in proper situa-
tions, well ventilated, and provided with all "ap-
pliances and means to boot," where their patients
should be under their own eyes, and strictly
watched and regulated in all respects as regards
exercise, . air, . diet, medicine, etc. ; or, there
should be a certain class of practitioners who
should exclusively pursue this practice as a dis-
tinct branch, to whom those in the large towns

OF PULMONARY CONSUMPTION. 45

should confide their consumptive patients, instead
of sending them, as many now do, to take their
chance, or probably to fall into the hands of
mercenaries at some distant sea-port where they
commonly die, far away from friends and
home.

With respect to the consumptive poor patients,
those who cannot afford to pay for a proper treat-
ment of this sort, hospitals should be established
in the vicinity of large towns, in fit situations, and
properly appointed in all respects for their recep-
tion and treatment. In these there should be
provision made for affording them carriage or
horse exercise ; and gardening, and farming
occupations, for the convalescent. The com-
mon hospital in a large town is the most unfit
place imaginable for consumptive patients, and
the treatment generally employed there very in-
efficient, arising frem the inadequacy of the means
at command.

With respect to the finders at Sheffield, who,
from the destructive effects of consumption

46 ON THE TREATMENT AND CURE

amongst them, arising from the inhalation of the
ikietallic and stone dust, do not live beyond the age
of thirty years, the necessity for an hospital for
their exclusive use and treatment is most urgent
on the score of common humanity and jus-
tice. These individuals actually throw away
half the term of their natural life, in the pursuit
of an occupation, by the results of which the rest
of mankind may feed themselves delicately. As
the immediate cause of the development of con-
consumptive disease in these individuals is ob-
vious, their removal from its influence, and early
treatment under a combination of favourable cir-
cumstances, in a hospital properly chosen for
them, and well conducted, would most likely
be productive of a great extension of the present
average term of their lives.

Connected with such . an hospital, provision
should be made for the employment of the con-
valescent and cured patients, who ought never to
return to their former occupation, but should be
employed after as agricultural labourers, gar-

OF PULMONARY CONSUMPTION. 47

deners, or in any other pursuit, rather than re-
turn to their former occupation.

One-fourth of the deaths which occur in Bir-
mingham, Manchester, and other large towns,
are from consumption ; and if ever there was a
necessity for an eflFort to arrest an evil of extraor-
dinary magnitude, that necessity is urgent in re-
gard to this most fatal of all diseases.

I have learned by experience that the surest
way in which a successful treatment can be
arrived at by thie medical man, is, by the recep-
tion under his own roof of the consumptive
patient; at the same time his house should be
in the country, in a situation airy and dry ; he
should have every means about him for the proper
exercise of the patient, in a carriage, on horse-
back, or a donkey, according to the ability and
taste of the invalid ; a swing boat is a good exer-
cise, and one which I have employed with much
advantage. The bed room should be cool and
airy, and properly ventilated ; everything relating
to thq patient^s health should be strictly watched

48 Oh THE TREATMENT AND CURE

and regulated by the practitioner ; above all, in
the medical treatment, there should be no bias
in the mind arising out of the theory preralent
in the schools, and in medical practice, and
termed '' phlogiston,^' giving rise to a treatment
called ^^ antiphlogistic/'

I have called the treatment herein adopted,
natural ; and not exactly in accordance witii the
received and adopted theory of inflammation, but
in accordance with the natural phenomena pre-
senting themselves to observation ; thus, the whole
structure being viewed as composed of so many
parts, the several parts difieriug from each other
in function and structure, the question presents
itself, — how would each be affected by the pre-
sence of a particular morbid affection ? as, for
instance, a deposition of tuberculous matter; —
taking, first, the higher order of organization, the
nervous filament^ spread out on the organ thus
affected, we should infer that their power would
be so affected by the presence of the foreign body,
as to be wa^ed or lost ; so that, by diminished

OF PULMONARY CONSUMPTION. 49

power, they could no longer control and preserve
in healthy action the blood-vessels, cellular tissue,
and other portions of the common organization ;
and as this action of the deposited matter would
occur upon the extremities of the nerves, the
capillary vessels would be affected by the loss of
nervous power, and losing, in consequence, their
contractility, or some portion of it, become dilated,
swollen, and congested ; and then would follow the
usual phenomena, commonly called inflammation,
terminating in suppuration or ulceration ; that is,
these vessels, losing the aid of nervous influence,
are no longer able perfectly to perform the office
of hydraulic tubes, carrying a fluid containing
solid particles in solution — the blood; hence
congestion, obstruction, and collection of the
solid parts of the blood in these vessels takes
place, terminating in abscess, ulceration, gan*
grene, or re-solution. The principles of treat-
ment I have ever found most suitable for the
removal of this diseased action, are founded
neither exclusively on the doctrines of Brown, or

F

50 ON THE TREATMENT AND CURE

on the Iheoiy of inflammation ; the truth, as far
as my experience goes, lies between the two ; as
regards the condition of the nerves of an organ,
and the supply of nervous energy, the reigning
power, and governing principle, without a due
supply of which, healthy actions in the lower
grades of organization cannot be maintained ; it
depends mainly upon a healthy and vigorous
state of the nutritive organs, by which the senso-
rium is supplied with the nourishing fluid, and
maintained in vigour. As far as this system, then,
is Qoncerned, the Brunonian theory, and the treat-
ment founded thereon, is the correct one; as
regards the dilated, loaded, and distended capil-
laries, with the heat, and congestion, and deposi-
tion of the solid parts of the blood, the treatment
founded on the theory of inflammation is the most
serviceable ; hence, local bleeding, by leeches or
cupping, may be useful and necessary to relieve
congestion of the blood-vessels in pulmonary con-
sumption ; but this is not inconsistent with the
steady employment of means for the purpose of

OF PULMONARY CONSUMPTION. 51

maintaining the integrity and perfection of the
sensorial functions, and of the whole nervous
system, on which, in fact, will at last depend the
chances of a permanent cure ; and for this object
it will be necessary to stimulate and preseiTe in
due force the natural powers of the system, by
the stimulus of wine and generous diet ; and to
prevent any undue exhaustion of nervous energy,
by the exhibition of anodyne and sedative medi-
cines upon a regular and systematic plan ; and by
the avoidance of all the common causes of nervous
exhaustion and debility, especially those of close
rooms and confined air, and of too exclusive a
use of the medical treatment termed " antiphlo-
gistic." As an illustration of my meaning, I may
mention the experiment of Majendie, who divided
the orbital branch of the fifth pair of nerves within
the cranium of a living animal ; the consequence
of which was, that the eye became affected with
all the symptoms and appearances of what is
called intense inflammation, and blindness ensued.
It is plain that the whole course of antiphlogistic

F 2

52 ON THE TREATMENT AND CUHfi

treatment, carried to its fullest extent, would fail
in such a case to care the eye ; but a restoration
of the nervous power, by re-union of the divided
branch, if that could have been effected, would
have cured it ; the antiphlogistic means would have
assisted, by unloading the distended vessels, and
facilitating their restoration to the natural calibre.
These would be the secondary means, but not
the principal ; and this is the view I take of
the treatment of pulmonary consumption, to restore
and preserve the perfection of the sensorial func-
tions, by which the due quantity of nervous
energy may be conveyed to the affected organ,
by the nerves supplying it ; secondarily to this,
as much of the antiphlogistic treatment as may
be deemed needful to relieve congestion and to
remove local obstruction, without in any way
compromising the normal state of the sensorial
and nervous functions.

The powerful effect of the early morning air,
in allaying excitement, and preventing the
exhaustion of nervous energy, in the nervous

OF PULMONARY CONSUMPTION. 53

extremities or filaments spread out and ii\ter-
woven with the substance of the lungs, with
which it comes into immediate contact, is so
great and so superior to all other means, that
it should, in my opinion, under the eye and by
the regulation of the medical attendant, form
the foundation of the whole course of treatment ;
without it, he will not be enabled to administer
the due proportion of stimulating and nutritious
aliment; it is the proper preparation for the
administration of medicinal sedatives ; by it the
muscular power is preserved from undue exhaus-
tion, and the sanguiferous system from running
away in waste ; for this course of treatment I
have invariably found to diminish the rapidity
of the pulse. The profuse nocturnal perspira-
tions are also soon subdued by this method of
treatment, and the great debility they occasion
avoided. The skin assumes a healthier action
in proportion to the extent of exposure to the
external atmosphere, particularly to the morning
air.

F 3

64 ON Ttifi tftfiATMENT AND CtRfe

If these views are in any wise correct, it is
obvious that the present position of medical
men generally is unequal to the task of under**
taking the cure of pulmonary consumption ; they
live in the towns^ for the most part, or large
villages, and are compelled on this account to
discharge the cases of consumption which they
meet with, to the sea coast or some watering
place, where probably but little interest is
taken with a view to cure them. I think
in the neighbourhood of every large town,
sufficiently distant to be clear of its contami*
nation from smoke, etc., and in well chosen
spots, medical men should be established with
all the means about them for the treatment of
the disease in question, to whom, those who
live in the towns should confide their patients
of this kind, at the same time rendering them
the benefit of their advice as far as needful,
rather than that they should be dismissed to
the care of nurses and lodging-house keepers,
in distant situations ; and again I repeat, I do

OP PULMONARY CONSUMPTION. 55

think that for the poorer classes, on account
of the magnitude of the evil as regards them,
hospitals especially for their use and treatment,
ought to be established in fit situations. For
my own part, from a decided conviction of the
benefit to be derived, and the great advantage
arising, from the reception of the consumptive
patient under the roof of the medical attendant,
provided the situation of his house is what it
ought to be, and all the means needful for the
treatment are at his command, I shall continue,
if I have opportunity, as heretofore, to receive
patients into my house, that they may have an
opportunity of obtaining whatever benefit is to
be derived from the plan of treatment herein
described. From the foregoing observations it
will be observed, that the medicinal treatment
has been confined almost entirely to the exhi*
bition of sedatives. Antimony and ipecacuanha
I decidedly object to; they do not go to the
root of the evil, are mere temporary remedies,
if remedies at all ; and they have a direct ten-

56 ON THE TREATMENT AND CURE

dency and do indeed always produce excessive
debility. With regard to the use of prussic
acid, and hydriod. potassae, both of which have
been extolled, there may be cases in which
their exhibition might be serviceable, providing
always that the system herein laid down, of
air, exercise, diet, etc., formed the chief part
of the treatment, but I have not hitherto found
it necessary to resort to their use, therefore can
say but little regarding their efficiency.

As far as my experience goes in the use of
carbonate of soda, which a$ also been extolled,
I decidedly object to it, believing, from closely
watching its effects, it has a tendency to cause
congestion and infiltration in the substance of
the lungs, when given for any length of time.
I infer thus much from having observed in-
creased dyspnoea and cough, and a purple
look of the skin, with a labouring small pulse,
to be the result of its exhibition. I believe
therefore in the coiTectness of Majendie's expe-
riment, wherein by the injection of this salt

OF 1?ULM0NARY CONSUMPTION. 67

into the veins of living animals, the po$t mor»
tern examinations invariably showed a congested
state of the Jungs, with infiltration into their
substance. Coupling this with my own obser*
vations of its effects on the human frame, in
cases of pulmonary disease, I have a great
aversion to its exhibition, or to that of the
nitrate of potass. I have found it advantage-
ous to avoid the use of all neutral salts, with
the exception of common salt, as a condiment
Since the foregoing was written, the case of the
young man before mentioned as under treat-
ment, has terminated fatally. Gurgling and
pectoriloquy of the left lung, with increased
dyspnoea, and every symptom indicative of the
almost total destruction of that portion of the
organ, with the occurence of diarrhoea on the
17th and 18th of September, terminated in
death on the 20th. Thus the sixth case
treated in the way herein recommended, has
proved unsuccessful. It remains to be seen
whether in future, five cases out of six can

68 ON THE TREATMENT AND CURE

be cured by this plan. Whatever occurs under
my own observation, if I have opportunity,
shall be faithfully recorded, whether in favour
of or against this method, to recommend and
extol which, at the expense of truth, is nei-
ther my wish or intention, but that there are
ample grounds to justify an extended trial of
the system, I think will be admitted gene-
rally, and with fair hopes of improved results
comparatively.

The chances against recovery in the
last case mentioned were great. The patient
had from early youth grown up with unusual
rapidity, being when about seventeen or
eighteen years of age nearly six feet in
height. He had suffered from a succession
of serious and dangerous diseases; namely,
fistula in ano, haemoptysis for several years,
and for a few months previous to the de-
velopment of the pulmonary disease, intense
hypochondriasis. Thus had the constitution
been undermined and weakened previous to

OF PULMONARY CONSUMPTION. 59

the attack of disease on the lungs, so that
this could hardly in fairness be admitted as a
case to test the efficacy of the treatment
applied.

In conclusion, I have to add, that the
natural, rational, and, so far as to my know-
ledge it has been tried, the successful treat-
ment of pulmonary consumption, appertains
exclusively neither to the thedry of phlogis-
ton, or inflammation, or to that of the Bru-
nonian system ; but it is a mixture of both :
As I believe both theories have truth in
them, but are not exclusively true, and indepen-
dent one of the other. Further physiological
investigations into the nature of nervous power,
and the influence it exercises over the san-
guiferous and other tissues, by its presence or
absence, or undue exhaustion or irritation, will
probably develope the true nature of those
changes of structure which occur under the
influence of disease, which are designated by
the term, "phlogosis*' or inflammation, Ian-

80 TREATMENT AND CUllB OF CONSUMPTION.

guage which not improbably is destined at
some future period, to be expunged from
medical science and literature; or at least,
to be understood as conveying very diflFerent
ideas of the nature of disease than are com-
monly implied in those terms at present, as
well as to effect a great change in the mode
and application of remedial agents generally.
The experimental labours of Magendie in
France, in relation to the operation of the
nervous power in animal life, and the inves-
tigations of Kieman and others in England,
as to the condition of the capillary vessels in
diseased parts, have both a direct tendency
to weaken the faith hitherto so universally and
implicitly placed in the old theory.

BxAMiifOKAii :— Printed by James Drake, 52, New-*treet.

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